Provider Demographics
NPI:1225259914
Name:POESCHL, STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:POESCHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 WASHINGTON AVENUE WEST
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:ALDEN
Mailing Address - State:MN
Mailing Address - Zip Code:56009-1004
Mailing Address - Country:US
Mailing Address - Phone:507-874-3662
Mailing Address - Fax:
Practice Address - Street 1:186 WASHINGTON AVENUE WEST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:MN
Practice Address - Zip Code:56009-1004
Practice Address - Country:US
Practice Address - Phone:507-874-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0870153OtherRENDERING NUMBER